which appeared on November 8, was about the various types and transmission patterns. This week is about signs and symptoms of hepatitis and prevention methods.

Regardless of which type of hepatitis virus is responsible, the signs and symptoms are similar in the acute phase of the infection. As mentioned before, following exposure, there is an incubation period during which the patient does not show any signs or symptoms, but is still infectious . Hepatitis A tends to have a more rapid onset of symptoms than the other types. The symptoms are typically non-specific. There may be malaise, low grade fever of less than 100 degree Fahrenheit or 38.5 degrees Celsius. there may also be nausea and vague abdominal pain. In some people a `flu-like illness will predominate, with a headache being prominent. Mild diarrhoea may also develop, although this is more common in hepatitis A. The stools or faeces may be clay coloured and the urine dark yellow.

Following this phase,the patient will become jaundiced. Jaundice is usually detected in the whites of the eyes and the skin. The skin may also feel itchy.

The liver maybe enlarged. Patients with severe hepatitis may have blood problems and will therefore bleed longer than usual if they have been cut etc.

Complications of hepatitis can be liver failure, liver cancer, cirrhosis of the liver and in some cases even death. Laboratory tests will determine which type of hepatitis is present.

Prevention depends on the type of hepatitis a person may be exposed to.

Vaccinations are available for hepatitis B only. People travelling to countries with a high prevalence of A and B can contact the Immunisation clinic at the Hamilton Health Centre on Victoria Street. Hepatitis C, D and E are only preventable by avoiding the various activities that place you at risk and countries that have a high prevalence.

The blood supply in Bermuda is always tested for the presence of hepatitis B.

Anyone diagnosed with type B in the past cannot donate blood. Further information can be obtained by calling 236-0224 ext. 240 or ext. 237 or your physician.

RHONDA DANIELS Nurse Epidemiologist